Provider Demographics
NPI:1316987381
Name:HAAS, RICHARD A (MD PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4555 WEST SCHROEDER DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:1249 W LIEBAU ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3333
Practice Address - Country:US
Practice Address - Phone:262-243-1244
Practice Address - Fax:262-243-1251
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI21702020207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30337800Medicaid
D33982Medicare UPIN